Annex A. Landscape analysis

Table A A.1. National initiatives for improving supply chain security
Policy Area	Initiative (main source), [start/end dates]	Scope of implementation	Aims and objectives	Governance	Outcomes and limitations
Stockpiling	Minimum stockholding requirements (Australian Department of Health and Aged Care, 2023[1]), [2023-]	Australia	Establish supply buffer for low-cost medicines: ‒ Manufacturers of low-price, shortage-prone drugs required to maintain stockpiles of 4 to 6 months supply. ‒ Manufacturers’ investments in stockholding mechanisms will be financed by a one-off price increase for medicines with ex-manufacturer price of < AUD 4 (~USD 2.60).	Designated criteria for determining which medicines and brands are subject to the stockholding requirement (noting that all prescription medicines in Australia are branded). A designated “responsible person” from the manufacturer must disclose its compliance with stockholding requirements to health authorities.	Around 3 000 brands for different medicines are included in the designated stockholding list.
Stockpiling	National Medical Stockpile (NMS) (Australian Department of Health and Aged Care, 2023[2]), [2012-]	Australia	Support front-line health services with additional resources when facing national health emergencies. Guarantee the continuous supply of medicines nationally, in a country highly dependent on imports. ‒ The stockpile provides PPE, medicines, vaccines and antidotes where commercial supplies are unavailable and there is demonstrable need for the products.	The stockpile is managed by the Department of Health and Aged Care. Inventories are dispersed around the country in undisclosed locations, and stocks are released at the request of state and territory governments.	In late December 2019, the stockpile’s inventory was valued at AUD 123 million (USD 87.8 million) (Australian National Audit Office, 2021[3]). The first large scale use was during the 2009 H1N1 influenza outbreak, when 900 000 courses of antivirals were distributed (ibid). During COVID-19, the stockpile was focused on purchasing PPE. Narrow stockpiling objectives and eligibility criteria for healthcare providers to receive goods from the stockpile during the pandemic were found to be obstacles in internal audits.
Visibility, Onshoring/ re-shoring	Drug Shortages Task Force (Government of Canada, 2023[4]), [2022-]	Canada	Consider novel approaches for addressing shortages and improving supply chain resilience for medical products, including initiatives for improved communication and transparency of shortages, greater supply chain visibility and the use of safety stocks for some essential drugs.	The task force engages provincial and territorial governments, industry stakeholders, healthcare system partners, patient groups and academia to develop a long-term strategy.	An online consultation received 160 written submissions, with the highest share coming from industry (45%). Respondents highlighted the need for increased transparency on shortages, including where products are available and possible alternatives. Increased visibility of inventory level data at different points of the supply chain was also raised as a necessary improvement, including improved tracking systems. Stakeholders also indicated the need for a list of essential drugs that could be subject to additional measures in case of shortages, and recommended improvements to shortage reporting requirements. Finally, stakeholders stressed the need for reinforced domestic manufacturing capabilities and procurement practices that also prioritise security of supply (Health Canada, 2023[5]).
Stockpiling	National Emergency Strategic Stockpile (NESS) (Public Health Agency of Canada, 2022[6]), [1952-]	Canada	Guarantee supply of essential medical equipment and pharmaceuticals to provinces and territories. ‒ NESS also works as the sole provider of some niche medical countermeasures, such as vaccines and antidotes and antivirals to respond to emergencies.	In Canada, emergencies are first managed at local level; managing healthcare systems is a shared responsibility of provinces and territories. If assistance is needed, provinces and territories can ask the federal government for support through the NESS.	N/A
Stockpiling	Centro de Reservas del Sector de Salud (CRSS) (Ministerio de Salud y Protección Social, n.d.[7]), [2010-]	Colombia	Support hospitals with medicines, PPE, antidotes and other medical products during health emergencies or disaster situations. Provide specialised teams to support disaster response efforts.	Stockpiles are maintained by the Ministry of Health and Social Protection and managed by the Centre of Communication and Co-ordination for Health Sector Emergency Response, which is responsible for supplying regional stockpiling centres. Stockpiles function at both national and regional levels.	N/A
On-shoring/ re-shoring	France 2030 (Ministry of Finance, 2023[8]), [2022-]	France	Support the development of strategic industrial sectors and ensure supply of key products and raw materials, such as semiconductors, batteries, and essential medical products. Guarantee access to medical products through public-private investments in France and Europe.	The France 2030 investment project is led by the General Investment Secretariat (SGPI), under the authority of the Prime Minister’s office.	A first investment of EUR 50 million for re-shoring projects has been announced. 50 medications have been selected to receive reshoring investment under the programme, of which 25 are already in process (Ministère de l’Économie,, 2023[9]).
On-shoring/ re-shoring	France Relance (France Stratégie, 2021[10]), [2020-]	France	Support the relocation of manufacturing in strategic sectors in France through co-financing.	The initiative is led by the Ministry of the Economy, which published a call for applications from companies seeking funding.	By February 2022, 106 projects in health had been awarded public grants of EUR 158 million, accompanied by EUR 561 million from industry stakeholders (France Relance, 2022[11]). 18 of the projects are aimed at re-shoring the production of 35 different APIs in France (ibid). A new paracetamol API factory with capacity to supply a third of Europe’s requirements for the product will be established in France with subsidies from this programme.
Visibility	TRACStock (LEEM, 2021[12]), [2020-]	France	Allow companies to share information of their stocks with competent authorities, particularly the medicine agency, in a confidential data environment managed by a trusted third party. ‒ TRACStock focuses on “Medicines of major therapeutic interest” (list of ~450 medicines established by the industry). ‒ The platform should be able to anticipate the possibility of shortages based on the data provided, and recommend alternative therapeutics, where available.	Implemented by Les Enterprises du Medicament (LEEM), an organisation representing 260 pharmaceutical companies. Manufacturers are responsible for providing information to the system regarding supply shortages. Only France’s regulatory agency, ANSM, has full access to the platform.	TRACStock has been focusing on monitoring stocks of, and demand for COVID-19 products in hospitals. By late 2023, more than 1 200 medications and 108 manufacturers are connected to TRACStock (LEEM, 2023[13]).
Visibility	DP-Rupture (LEEM, 2019[14]), [2013-]	France	Create links between pharmacists, industry providers, and national regulators to monitor the timeliness of pharmaceutical delivery to pharmacies across the country. ‒ Allows hospital pharmacists and practitioners to signal supply issues to the supplier and the competent authorities (ANSM). ‒ Allow companies to have a clearer picture of products’ supply and distribution, allowing them to communicate supply disruptions to pharmacists in advance.	A platform implemented by France’s National Chamber of pharmacists.	262 retail pharmacists, 4 hospital pharmacies, 4 wholesale distributors and 50 laboratories participated in a trial phase in 2014. During this trial, 1944 shortage declarations were made, with nervous and cardiovascular system medicines the most widely reported (Bordas, Duplay and Buxeraud, 2014[15]).
On-shoring	Program for Promoting Investment in Japan to Strengthen Supply Chains (Ministry of Economy, Trade and Industry, 2023[16]), [2020-]	Japan	Secure a domestic production base of essential products in case of emergencies. Support businesses in building new plants and new facilities to produce essential materials in Japan, based on companies’ own judgements to strengthen supply chains.	The Ministry of Economy, Trade and Industry is responsible for selecting applicants to receive government subsidies in order to secure domestic production bases. A third-party committee of experts was tasked with selecting the companies that would receive government subsidies	57 companies were selected in July 2020 to receive JPY 57 billion (USD 537 million) from government subsidies to secure domestic production bases. The current list of health-related products includes PPE, reagents for PCR tests, and logistics kits for pharmaceuticals (e.g. cold chain), syringes etc.
Stockpiling	Korea National Stockpile (OECD, 2020[17]), [Start date unclear]	Korea	Stockpile a variety of medicines and other essential medical products.	The Ministry of Food and Drug Safety develops a list of the essential medical products that must be stockpiled. Stocks are maintained by both national and local authorities. National legislation provides that the stockpiling for disaster management must be reviewed every year by the agency responsible for keeping such stocks.	The list of essential medicines stockpiled currently contains 351 different products (Ministry of Food and Drug Safety, 2019[18]). Recent measurements of volumes of stockpiled antivirals indicated quantities sufficient for 26% of the population, above the WHO-recommended level of 20%.
Visibility	Availability of information on manufacturers’ location for API and other components of authorised medicines by the Medicines and Medical Devices Safety Authority (MEDSAFE) (MEDSAFE, 2021[19]), [Start date unclear]	New Zealand	Provide publicly available information on manufacturers’ names and locations for APIs, finished dosage forms, packaging, and testing, and sites of domestic product release, among other essential data.	The database is maintained by MEDSAFE, New Zealand’s regulatory agency for medicines and medical devices.	Supply chain information is made available to the public. The database does not provide any additional data on volume and manufacturers’ name and location for excipients.
Stockpiling, on-shoring	Strategic Reserve based on National Industrial Production Capacities (RECAPI) (Ministerio de la Presidencia, Relaciones con las Cortes y Memoria Democrática, 2021[20]), [2021-]	Spain	As part of a wider reform of the national security system, ensure the supply of essential products to the Spanish economy and essential public services, including medical products. Identify essential industrial resources for all sectors of government and establish basic production capacities to guarantee supply of essential products during exceptional circumstances.	An inter-ministerial council, with the support of an operational secretariat, is responsible for establishing the strategies and priorities of the RECAPI strategy.	A methodology for conducting dependency mapping of pharmaceuticals and API is currently being developed.
Stockpiling, visibility	Switzerland stockpiling system (FOPH, 2022[21]) [1951-]	Switzerland	Guarantee the uninterrupted supply of essential medicines.	Stockpiles are maintained and owned by private firms, but the Federal Office of National Economic Supply (FONES) determines the products and volumes that should be kept in a rolling stock system. A diverse set of medicines is included, as well as selected vaccines, and veterinary medicines. FONES orders the release of privately held supplies when faced with a shortage.	During the first months of the COVID-19 pandemic, the Swiss Federal Office of Public Health (FOPH), in partnership with FONES, developed a prioritisation strategy for allocating essential medicines to hospitals facing shortages. The rolling stock scheme allows for better monitoring of overall supplies and demand for essential medicines by public health authorities. A catalogue of 30 APIs essential to respond to the COVID-19 pandemic that would require stockpiling was developed after the first wave in 2020. Strict weekly monitoring of stocks, deliveries and demand for these products was implemented. Rolling stockpiles were considered an efficient and effective strategy to respond to shortages during COVID-19. However, international co-ordination and global market oversight have been identified as key areas for improvement in public audits.
On-shoring/ re-shoring	Reshoring UK (Reshoring UK, n.d.[22]), [2014-]	United Kingdom	Connect manufacturers with trusted suppliers that match their requirements. Encourage UK companies to engage with domestic manufacturers in their supply chain.	A public-private collaboration of industrial engineering associations manages Reshoring UK initiatives.	N/A
Onshoring/ reshoring	Life Sciences Sector Deal (Office for Life Sciences, 2018[23]), [2018]	United Kingdom	Increase the country’s attractiveness for domestic production of advanced therapies.	The life sciences sector deal is part of the UK Government industrial strategy. It combines input from industry, academia, and charity partners to determine the areas for funding prioritisation.	GBP 181 million (USD 241 million) was reserved by the UK Government to support growth in life sciences manufacturing. Industry stakeholders from have also announced a series of investments in line with the government priorities.
Onshoring/ reshoring	Manufacturing USA (Deloitte, 2017[24]), [2014-]	United States	Increase competitiveness of US manufacturing. Facilitate the scaling-up of production and improving the cost-effectiveness of innovative technologies. Accelerate the development of an advanced manufacturing workforce.	Public-private collaborations form eight institutes, each focused in one area of innovation and/or manufacturing. These institutes form networks for collaboration among stakeholders from academia, industry, and government.	By late 2016, the US Government had committed USD 600 million in investments towards the initiatives of the institutes. This investment was matched by USD 1.3 billion in investments from industry and other stakeholders.
Stockpiling	Strategic National Stockpile (SNS) (ASPR, n.d.[25]), [1999-]	United States	Provide emergency medical supplies to states and local health jurisdictions in the event of a bioterrorist attack or other public health emergency.	The stockpile is managed by the Administration for Strategic Preparedness and Response (ASPR). The list of products to be stockpiled is defined by the HHS Secretary following advice by an inter-agency working group (generally including medicines, vaccines, medical products, and ancillary supplies) Most supplies are stored in SNS-managed physical storages facilities, but vendor and user-based inventories are also used. Vendor-managed inventories account for 10% of current SNS contracts and are directly funded by the SNS.	During the recent mPox outbreak, the SNS provided 1 million vials of JYNNEOS vaccines (CDC, 2022[26]). During the COVID-19 pandemic, the SNS focused on supplying PPE to all US states, the country’s four largest cities, and other jurisdictions in need. The stockpile proved to be ill-prepared and lacking sufficient resources to respond effectively to the COVID-19 pandemic. Management of the stockpile has been reported to be inefficient.
Note: This list of initiatives should not be considered to be exhaustive. NA not applicable or not available; PPE personal protective equipment; API active pharmaceutical ingredient.
Exchange rates have been converted to USD using the OECD Statistics database and based on the average rate for the year the initiative was first implemented.

Table A A.2. Regional and multi-country initiatives for improving supply chain security
Policy Area	Initiative (main source), [start/end dates]	Scope of implementation	Aims and objectives	Governance	Outcomes and limitations
Procurement	Gulf Co-operation Council (GCC) (DeRoeck et al., 2006[27]), [1978-]	Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, Yemen, and the United Arab Emirates	Ensure availability of quality medicines at lower prices. Ensure continuous supply of medicines and medical products throughout the year. Standardise procurement policies, processes, and quality, price and manufacturers of medicines used in GCC countries.	GCC Executive Board, supported by committees with representatives from all countries for each step of the tendering process. Countries must first inform on their public sector vaccine demand. The GCC centralises the tender and bid process, however each country contracts and pays suppliers individually. Member countries are required to purchase at least 60% (by value) of their total needs for each product category. Contracts with pre-selected providers are awarded based on best price.	By 2003, 10 tenders had been issued, covering 8 900 different products worth USD 508 million.
Visibility	European Shortages Monitoring Platform (ESMP) (European Council and Parliament, 2022[28]), [Implementation planned for 2025]	EU	Create a single European platform to exchange information on essential medicines during public health emergencies (PHE) and major events, using a standardised minimum information set MAHs must provide to regulators. ‒ The dataset will include information on supply and demand for critical medicines considered relevant during a PHE or major event, in addition to the identification of its API manufacturing sites, details of alternative medicinal products, and other essential data.	The system will be established and managed by the EMA. Primarily, national competent authorities and single points of contact in MAHs will be the main providers of information to the ESMP. The ESMP will also be capable of processing information received directly from MAHs, wholesale distributors and other relevant entities.	Under current plans, only information on medicines identified as essential to respond to a PHE or a major event, and medicines for which shortages could give rise to a PHE/ major event will be collected by ESMP. The 2023 European Commission Pharmaceutical Legislation reform aims to expand the use of the platform to non-critical scenarios. The platform is planned for implementation from 2025.
On-shoring/ re-shoring	EU Important Projects of Common European Interest (IPCEI) for the pharmaceutical industry (European Commission, n.d.[29]), [2022-]	EU	Identify industrial sectors considered strategic for the European economy and competitiveness. Support the development of technologies and production capacity for strategic medical products. Contribute to the objectives of the European Health Union and the Industrial Strategy for Europe.	Selected projects are agreed and funded by EU member states, which also determine the main areas of focus and the selection of projects to be funded.	16 EU countries have agreed to continue work towards deployment of the IPCEI for the pharmaceutical industry. IPCEIs are considered excessively bureaucratic to implement. They are mainly aimed at developing innovative projects. Although these have the potential to become long-term investments, they may not solve current shortages affecting older technologies.
Visibility	Executive Steering Group on Shortages and Safety of Medicinal Products (MSSG) (EMA, 2023[30]), [2022-]	EU	Provide oversight of the supply of medicines for the European market in response to crises. Develop lists of pharmaceutical or therapeutic subgroups considered essential for emergency care, surgery, and intensive care, which will also inform the establishment of ad hoc lists of critical medicines to be monitored during major crises or public health events. Advise the Commission regarding scenarios that should be recognised as “major events”, in accordance with Reg EU 123/2022. Co-ordinate activities to prevent and mitigate the effects of medicine shortages.	MSSG is a permanent executive body of the EMA. It includes representatives from each EU member state, a delegate from the European Commission and a delegate from the EMA. Wherever possible, decisions are adopted by consensus, otherwise by an absolute majority.	Since its implementation, regular MSSG meetings have monitored the availability of essential medical products to respond to ongoing health emergencies, such as COVID-19 and mPox. Following a surge in respiratory infections, since November 2022 the MSSG has been monitoring the supply of amoxicillin-containing antibiotics in the EU. After exchanges with EU Member States and taking account of regulatory flexibilities and increases in supply, the MSSG determined that the current shortage should not be considered a major event.
Stockpiling	rescEU (European Commission, 2022[31]), [2019-]	EU countries and, in some cases, non-EU countries such as Montenegro, North Macedonia and Ukraine	Provide countries with essential material and human resources to respond to emergencies. Support can only be approved when countries’ own resources are not able to fully respond to the emergency.	Stockpiles are held in 9 EU member countries, which are also responsible for their maintenance, logistics and procurement. The European Commission provides funding for the programme. Countries request assistance to the Emergency Response Co-ordination Centre (ERCC), a EU body responsible for co-ordinating civil protection activities. ERCC evaluates the ability of rescEU resources to support the country’s request and deploys the resources.	The stockpile has been a key element in the EU’s response to the pandemic, supplying various EU and non-EU countries with PPE, ventilators, and protective masks. rescEU has supported Ukraine with ventilators, infusion pumps, masks and gowns since the beginning of the war in the country. To date there are no reports of rescEU providing countries with medicines, although they are also stockpiled.
Visibility	Heads of Medicine Agency (HMA) – European Medicines Agency (EMA) Joint Task Force on Availability of Authorised Medicines for Human and Veterinary Use (TF AAM) (HMA, n.d.[32]), [2016-]	EU	Provide strategic guidance for structural actions to be taken outside crises in order to address shortages of medicines in Europe. Work as a “supply and availability” hub that tracks information for different EU-level projects. Provide guidance for stakeholders on how to address different shortage situations.	The Taskforce comprises a Steering Committee and two thematic working groups (availability and supply disruptions, and communications). The Steering Committee is composed of representatives from EU Member States and HMA bodies, and co-chaired by an HMA representative and an EMA senior staff member.	The Taskforce’s 2021-25 work programme includes drafting proposals for the new EU pharmaceutical legislation on preventing and managing shortages, assessing which recommendations of a European Commission report on root causes of shortages can be implemented, and establishing the EU list of critical medicines (EMA, 2022[33]). The Taskforce has organised workshops with stakeholders from EU Member States to debate better practices, discuss challenges and develop strategies to prevent and manage shortages. Multiple guidance documents have been published to support different stakeholders in managing and communicating shortages both among themselves and with the public.
Procurement	EU Directive recommending the preferential use of Most Economically Advantageous Tender (MEAT) procedures in public procurement (European Parliament and the Council of the European Union, 2014[34]), [2014-]	EU	Award tender contracts based on criteria other than price (i.e. adapt tendering criteria to the context). Utilise the procurement process to incentivise firms to achieve other policy objectives, such as more secure or more environmentally friendly supply chains.	National competent authorities or ministries of health define the organisation of tenders and the definition of award criteria.	Despite the EU directive, the uptake of MEAT has been limited. The extent to which security of supply has been included as a criterion is unknown (Vogler, Salcher-Konrad and Habimana, 2022[35]). MEAT only applies to public procurement, which accounts for significant market share in EU countries, especially for older off-patent products used in hospitals, the sector most severely affected by shortages.
Cooperation	Coordination and Harmonisation of the Existing Systems against Shortages of Medicines – European Network (CHESSMEN) (2023[36]), [2023-2026]	21 EU member states and 1 EEA country	Coordinate joint action by European countries against medicine shortages. Support the harmonisation of definitions and standards by collecting country-specific data and definitions. Identify countries’ best practices in managing and preventing medicine shortages.	The initiative brings together participating countries and 5 affiliated entities under the co-ordination of the Italian Medicines Agency (AIFA). With co-funding and support from the European Commission, 7 different work packages led by different European national regulatory authorities are responsible for carrying out CHESSMEN’s focus areas of work. The initiative is planned to last for 3 years.	N/A
Procurement	Baltic Procurement Initiative (Estonian Ministry of Foreign Affairs, 2021[37]), [2012-]	Estonia, Lithuania and Latvia	Joint procurement of medical products, secure access, and better prices for medicines. Facilitate mutual “lending” of medicines to partner countries facing shortages.	For each period, countries agree to jointly tender for medical products, and a lead country is selected to procure on behalf of others.	Since its implementation, the initiative has conducted four tenders for different vaccines that have been considered successful. Award criteria other than price have rarely been considered, and security of supply has not yet been used.
Procurement	Pan-American Health Organization (PAHO) revolving fund (PAHO, 2021[38]), [1977-]	41 countries in Latin America and the Caribbean	Support smaller countries’ access to essential vaccines through a regional collective purchasing process. Achieve lower prices through collective bargaining. Provide technical expertise in procurement to countries with lesser resources. When feasible, ensure security of supply by awarding more than one bidder for a certain product. Ensure consistency and continuity in countries’ vaccination programmes by allowing them to receive deliveries before reimbursing the fund. Support countries’ efforts and expertise to forecast demand for vaccines.	Country annual vaccine demand forecasts are submitted to PAHO, which consolidates purchase orders and conducts the entire tendering process up to delivery to countries. From a list of pre-qualified bidders, the one offering the lowest price is awarded the contract. PAHO pays manufacturers up front and is only reimbursed by countries after delivering the purchased products.	47 types of vaccines were procured from 38 providers in 2021, amounting to USD 1.07 billion. 100 million people have been impacted by the regional revolving funds. Regular demand forecasting for vaccines, with technical assistance provided by PAHO, has provided more certainty for manufacturers. Vaccine shortages and delays in delivery were already reported. During periods of surges in demand, vaccine manufacturers were not able to meet PAHO’s requests on time.
Procurement, visibility	Nordic Pharmaceutical Forum (NPF) (Nordic Pharmaceutical Forum, 2023[39]), [2015-]	Norway, Denmark, Sweden, Iceland, and Finland (observer)	Increase participants’ purchasing power through collective bargaining and ensure security of supply. Focus on purchasing older medicines. The initiative also serves as a platform for sharing information on horizon scanning, manufacturing, and logistics. Supply chain security and environmental award criteria were also included in tenders.	A steering group chaired by Denmark co-ordinates the tendering process. Participating countries can join individual tenders voluntarily.	A pilot programme helped the setting of priorities for the joint procurement processes and an extensive market survey with suppliers was held to inform the procurement process. Two successful joint tenders for off-patent medicines have been concluded. Procurement agencies in smaller countries have been able to leverage partner countries’ expertise.
Visibility	Centre for Information on the Supply of Medicines (CISMED) (Consejo General de Colegios Oficiales de Farmacéuticos, 2023[40]), [2019-]	Spain (also collaborating with France, Italy, and Portugal)	Anticipate shortages by allowing pharmacies to report real-time daily information on patient-level supply issues. Exchange information on shortages faced by countries and support standardisation in recognising and reporting shortages, and methods for quantifying supply problems. Expand this system to all European countries in future.	The original system was managed by the General Pharmaceutical Council of Spain. A joint initiative between Spain and three other European countries to exchange information based on the CISMED design comprises entities representing pharmacies in each of the collaborating countries. The project is part of the Digital Health Europe twinning scheme, with funding from the European Commission.	The cross-country collaboration has demonstrated the feasibility of information-sharing between countries on shortages in medical supply chains (e.g. a comparative analysis of shortages identified a large increase in shortages of neurology medications in all four countries between 2019 and 2020). Digital Health Europe states that the system was particularly relevant in the context of the COVID-19 pandemic.
Visibility	Canada-U.S. Working Group on supply chains (The White House, 2022[41]), [2021-]	United States and Canada	Enhance co-operation between the two countries, whose supply chains are deeply interconnected, through economic analysis of risks and mapping of key supply chains, including critical medicines, medical devices and PPE. Identify areas for greater alignment between the countries in regulatory requirements and manufacturing of essential medical products.	The working group is composed of representatives from the United States and Canada, with a mandate to provide analyses and recommendations.	A progress report released in November 2022 has led to closer collaborations between the US Administration for Strategic Preparedness and Response (ASPR), Health Canada, and the Public Health Agency of Canada on stockpiling and regulatory flexibilities for critical medical supply chains.
Visibility	USAID Global Health Supply Chain Program (GHSC) (USAID, 2023[42]), [this programme started in 2015, although programmes under this umbrella had existed before-]	Funded by the US Government, the programme is present in more than 65 low- and middle-income countries in Latin America, Africa, Asia and Oceania.	Achieve more resilient health supply chains by providing modern procurement and quality assurance tools, and other country-specific technical assistance. ‒ The GHSC programme also provides tools standardising the information on medical products to facilitate co-operation between supply chain operators, improve planning and avoid duplication of data. Ensure continued availability of medicines for HIV, family planning, maternal and child health, and emerging public health threats.	A series of 8 complementary projects are managed by the United States Agency for International Development.	The procurement funding branch of GHSC has delivered health commodities worth USD 4.4 billion since its creation. In 2022, global standards for product identification, location identification and product master data for health commodities were implemented in 10 countries, which helped improve the availability of products in health supply chains. The project has also explored ways to increase regional production capacity in Africa for essential medicines such as antiretrovirals.
Note: This list of initiatives should not be considered to be exhaustive. NA not applicable or not available; PHE public health emergency; MAH marketing authorisation holder; API active pharmaceutical ingredient.
Exchange rates have been converted to USD using the OECD Statistics database and based on the average rate for the year the initiative was first implemented.

References

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